request for proposal - fairfaxcounty.gov · a joint proposal, the proposal may ... community...

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REQUEST FOR PROPOSAL

FAIRFAX COUNTY CONSOLIDATED COMMUNITY FUNDING POOL

RFP# 2000002372FISCAL YEARS 2019–2020

T his Request for Proposal is to solicit appli-cations from eligible programs and services offered by Community-Based Organiza-

tions (CBOs) to provide health, housing and human services to residents within one or more regions of the County of Fairfax for the Consolidated Commu-nity Funding Pool (CCFP).

Funding in the CCFP is available from a combina-tion of local, state and federal sources:

Federal and State Community Services Block Grant (CSBG) (approximately 6% of total funds)

INTRODUCTION

Federal Community Development Block Grant (CDBG) (approximately 15% of total funds)

Fairfax County General Fund (approximately 79% of total funds)

Contracts will be awarded for a two-year period, beginning July 1, 2018 through June 30, 2020. An estimated $12 million will be available for each of the two fiscal years. The final amount will be determined upon the Board of Supervisors’ approval of the Fairfax County Fiscal Year 2019 and Fiscal Year 2020 budgets.

BACKGROUND

In 1997, Fairfax County, Virginia developed and implemented a new competitive grant process for funding human services programs developed by

non-profit agencies. In 1998, the Board of Super-visors established the Consolidated Community Funding Advisory Committee (CCFAC) to oversee the county’s Consolidated Plan and Consolidated Community Funding Pool (CCFP) policy, planning and development of priorities and proposal evalu-ation criteria. The committee is comprised of rep-resentatives from nine (9) Fairfax County Human Services Boards and Commissions and several community sectors. The committee works in part-nership with the Community Action Advisory Board to determine the program areas for CCFP awards funded through the Community Services Block Grant (CSBG) allocation to Fairfax County, and col-laborates with the Fairfax County Redevelopment and Housing Authority (FCRHA) to allocate non-CCFP funding in the County’s Consolidated Plan.

Throughout the CCFP’s history, the CCFAC have strategically adjusted the priorities to meet the county’s changing needs and to recognize the changing nature of community-based providers. For FY 2019-2020, the CCFAC decided to revamp the priority setting process to ensure that the approach was more aligned with existing human services efforts and reflected community input. This decision to overhaul the priority setting process also supports the recommendations of the CCFP Steering Com-mittee. In order to achieve this, Fairfax County staff hosted various community engagement sessions throughout the county to gather input about the priorities as well as emerging needs.

Based on the community feedback, supportive data, and human services outcome information provided by staff, the CCFAC identified and developed new CCFP priority “categories” and outcomes state-ments. These new priorities represent the existing

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agency, a current County employee or member of the Consolidated Community Funding Advisory Committee (CCFAC).

The SAC evaluates proposals according to the fund-ing priorities and established evaluation criteria. The SAC will conduct a preliminary evaluation and rating of the technical information in each proposal on the basis of the criteria listed on page 9, including the Demonstration of Need, Outcomes, Approach and Organizational Capacity. The cost information will be evaluated and rated only for the proposals with the highest preliminary ratings. Affordable Housing Capital Projects will be evaluated on three additional criteria.

The SAC will make funding recommendations to the Board of Supervisors for approval. Applicants will be notified of the recommendations and action by the Board of Supervisors in late April 2018. Approved programs will be awarded funds through a contractual agreement with the County, subject to negotiations of final terms and conditions conducted in May and June of 2018. The terms of the contract will begin July 1, 2018. Unsuccessful applicants may request a meet-ing to receive feedback on proposals after awarded contracts have been signed, usually after July 1.

HOW TO APPLYThis Request for Proposal includes two submission formats for Applicants who are requesting $50,000 or less per year (pages 20–23) and those Applicants requesting more than $50,000 per year (pages 13–18). There are instructions on how to apply for both funding levels. Applications may be submitted by mail or delivered in person. All applications must be received by December 4, 2017, at 2:00 p.m. at the following location:

Fairfax County Department of Procurement and Material Management

12000 Government Center Parkway, Suite 427Fairfax, Virginia 22035

BASIS FOR AWARDSA Selection Advisory Committee (SAC) comprised entirely of Fairfax County residents, is appointed by the County Executive to recommend propos-als for awards. Individuals on the SAC serve on a volunteer basis and must reside in Fairfax County. SAC members may not be a current offi-cer, employee, or Board member of an Applicant’s

and emerging needs noted by the community and align with health and human services determinants that will result in positive and equitable outcomes and are not in any specific priority or ranking order.

To determine how CCFP funds should be used, the CCFAC:

Reviewed human services needs and program utilization data from county agencies and other sources, including existing CCFP programs; and

Conducted community engagement sessions, utilized social media outlets to derive feedback, and invited all interested parties to present their comments on the proposed priority areas.

For the FY 2019-2020 funding cycle, the CCFAC organized the Funding Priorities according to six priority areas listed on pages 5–7 under Proposal

Guidelines of this RFP. The Fairfax County Board of Supervisors approved the Funding Priorities on June 20, 2017. The funding pool Priorities and its requirements reflect the county’s emphasis on out-come accountability based less on what is done for clients and more on how the lives and conditions of clients are improved as a result of the programs.

The Board Action Item to approve the Priorities and a description of them are found in the Fiscal Years 2019 and 2020 Consolidated Community Funding Pool RFP Funding Application Resource Manual (hereafter called the Resource Manual), which provides guidance for all applicants.

This Request for Proposals is the thirteenth since the creation of the CCFP. For information on previously funded programs, please visit www.fairfaxcounty.gov/ccfp.

REQUEST FOR PROPOSAL

www.fairfaxcounty.gov/ccfp

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PROPOSAL GUIDELINES

A ll proposed programs should address no more than two of the funding priorities listed below. In the case of programs for which multiple organizations are collaborating on a joint proposal, the proposal may target up to a maximum of three priority areas.

Service examples may include but are not limited to the examples listed in each priority area below.

PRIORITY OUTCOME STATEMENT SERVICE EXAMPLES I. HOUSING Families and individuals of all ages and abilities — including those at risk of homelessness, people with disabilities, older adults and individuals in the local workforce — can afford safe, stable, healthy, and accessible living accommodations along with other basic necessities and will have access to affordable, accessible ` `housing with the supportive services necessary to live as independently as possible in a community setting.

II. LITERACY/ Families and individuals of all ages and EDUCATIONAL abilities will have the ability to read, write DEVELOPMENT/ and speak English effectively, manage ATTAINMENT finances, and attain employment goals through academic and vocational achievement. Children and youth will have access to quality early care and education and supports to develop employment and independent living skills.

• Housing modifications for ADA accommodations, enable seniors to age in place and other housing rehabilitation projects.

• Provision of temporary or emergen-cy shelter and supportive services to homeless individuals and families, including homeless youth.

• Services to support housing stabil-ity and to maximize tenants ability to live independently (e.g., case management, mental health, alcohol and substance abuse, independent living, home health visits, vocational, health, furniture and other house-hold goods, peer support and social activities).

• Acquisition, preservation, rehabilita-tion, and construction of affordable, accessible, safe, healthy, and stable housing with accessible supportive social services.

• Services to assist individuals transi-tioning from institutional to home or community-based care.

• Services to assist individuals and families to locate housing.

• Early Childhood development services• Employment training/job skills/

awareness of economic opportunities.

• Adult education• English proficiency services• Supportive employment

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PROPOSAL GUIDELINES

PRIORITY OUTCOME STATEMENT SERVICE EXAMPLES III. FINANCIAL Families and individuals of all ages and STABILITY abilities will have the ability to possess and (Financial maintain sufficient income to consistently Assistance to meet their basic needs — with no or minimal Financial financial assistance or subsidies from Empowerment) private or public organizations.

IV. HEALTH Families and individuals of all ages and abilities will have access to primary, specialty, oral and behavioral, and long-term health care, particularly prevention services. Families and individuals of all ages and abilities will develop the knowledge and resources to practice healthy behaviors and to take action to prevent and manage disease and adverse health conditions. Children will have access to supplemental food year-round, seven days a week.

V. SUPPORT/ Families and individuals of all ages, abilities COMMUNITY/ and income levels will have access to local SOCIAL services, including community-based NETWORKS transportation and childcare and the ability to establish and maintain communal and social relationships.

• Financial literacy/management train-ing and counseling to foresee and prevent financial crises

• Utility payments• Rental assistance• Financial counseling• Financial asset formation

• Healthcare affordability and acces-sibility services, particularly oral and behavioral services

• Health fairs and health screening clinics, dental clinics, inoculations, nutrition education

• Primary medical/dental services• Healthy choices programs• Emergency and/or supplemental

food programs (weekend backpack programs)

• Nutrition education programs

• Courses that teach language or culture to help groups interact positively

• Mentoring programs for youth, adults, and families

• Language and cross-cultural assistance

• Transportation to provide access to existing programs, services and/or medical appointments

• Social environments for isolated individuals

• Respite services to help caregivers• Childcare to help parents stay

employed

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PROPOSAL GUIDELINES

PRIORITY OUTCOME STATEMENT SERVICE EXAMPLES VI. POSITIVE Families and individuals of all ages, BEHAVIORS abilities and income levels will develop AND HEALTHY positive behaviors and healthy relation- RELATIONSHIPS ships that are safe and free from abuse, neglect and trauma and promote physical, emotional, mental and social well-being.

• Counseling services for individuals and families

• Conflict resolution and anger man-agement training and counseling

• After-school or other programs that provide positive alternatives to risky behavior

• Services to victims of domestic violence and their families

• Services to assist with trauma recovery

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PROPOSAL GUIDELINES

1. ELIGIBLE APPLICANTS: a. Organizations with nonprofit 501(c)3 tax

exempt status, or organizations that have established their 501(c)3 tax-exempt status by July 1, 2018, including faith-based or religious organizations. If funded, proof of 501(c)3 certification will be required.

b. Applicants may be based in jurisdictions other than Fairfax County provided that the proposed program exclusively benefits eligible residents, depending on the funding source, as defined below:

i. Programs funded through the Fairfax County General Fund may only serve residents of Fairfax County or the Towns of Clifton, Herndon or Vienna.

ii. Programs funded through the Community Services Block Grant may serve resi-dents of Fairfax County or the Towns of Clifton, Herndon or Vienna and may also serve residents of the Cities of Fairfax and Falls Church. Awards funded through the CSBG must benefit residents at CSBG income levels referenced in the Resource Manual, page 39. Awards made with CSBG funds may be designated for hous-ing, education, employment, childcare and emergency programs.

iii. Programs funded through the Federal Community Development Block Grant funds may serve residents of Fairfax County, the City of Fairfax, or the Towns of Clifton, Herndon or Vienna. Applicants for new housing construction must be Com-munity Based Development Organizations (CBDO’s) as defined in the Resource Manual, Frequently Asked Questions, page 47. Awards for Capital Projects will only be made for projects that result in the produc-tion or preservation of affordable housing located in Fairfax County or the Cooperat-ing Jurisdictions of the City of Fairfax and

the Towns of Clifton, Herndon and Vienna. Affordable Housing Capital Project awards must comply with CDBG regulations and guidelines.

c. Organizations that are in receivership status or debarred by the U.S. Government and/or Fairfax County are not eligible.

d. Organizations whose county contract award has been terminated for cause within the last two years are not eligible.

2. PROGRAM AWARD PROVISIONS: a. All awards are subject to the County of

Fairfax General Conditions and Instructions to Bidders found in the Resource Manual, page 27 and Special Provisions also in the Resource Manual, page 4.

b. All programs receiving funds from the Community Services Block Grant and Community Development Block Grant will be subject to all Federal and State laws, regulations and guidelines governing those grants. Awards utilizing these federal funds may result in a subrecipient designa- tion and as such must comply with Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards.

c. Each organization awarded a contract for FY 2019-2020 will be required to implement a quality assurance plan for identifying and correcting deficiencies in the quality of services before the level of performance becomes unacceptable and/or the county staff identifies deficiencies.

d. An emergency preparedness plan to include continuity of operations, succession of responsibility and preparation of staff must be provided upon contract startup date.

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EVALUATION CRITERIA

T he SAC will use established evaluation criteria to rank each proposal submitted. Each criterion element is rated separately. Proposals may receive up to the maximum points allowed based on the response to each criterion element. A detailed description

of each criterion is included in this RFP. Collaborative proposals1 are highly encouraged.

Funding allocations are based on the Applicant’s ability to adequately address the following:

ALL APPLICATIONS will be considered on the following criteria:

TECHNICAL PROPOSAL: Maximum Points

Criterion A Demonstration of Need 15 points

Criterion B Outcomes 25 points

Criterion C Approach 20 points

Criterion D Organizational Capacity 20 points

COST PROPOSAL:

Criterion E Budget and Budget Justification 20 points

TOTAL 100 points

APPLICATIONS FOR AFFORDABLE HOUSING will also be considered on the following additional criteria:

TECHNICAL PROPOSAL: Maximum Points

Criterion F Consolidated Plan Priorities 15 points

Criterion G Impact on Affordable Housing Stock 15 points

COST PROPOSAL:

Criterion H Project Financing & Operating Budget 10 points

SUBTOTAL 40 points

TOTAL 140 points

____________________1Collaboration is defined as two or more organizations joining together through written agreement to provide services based on common goals and shared funding. Partners agree to pool resources and jointly plan, implement and evaluate new services and procedures. They also agree to delegate individual responsibility for the outcomes of their joint efforts. Only one of the organizations would submit a proposal on behalf of the collaboration.

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PROPOSAL INSTRUCTIONS

1. PROPOSAL PREPARATION Applicants must include the following in the

order listed below, in their proposal submission:

TECHNICAL PROPOSAL Form 1: Proposal Cover Sheet (DPMM32)

must include offeror authorized signature Table of Contents

Form 2A or 2B: Proposal Narrative Form • Demonstration of Need • Outcomes • Approach • Organizational Capacity

Form 3: Program Outcome Worksheet

COST PROPOSAL Form 4: Program Budget Form 4A: Program Personnel Budget Form 4B: Program Budget Justification Form 5: Estimated Program Revenues

RENTAL HOUSING & CAPITAL PROJECTS ONLY:

Applicants submitting AFFORDABLE HOUSING CAPITAL PROJECTS should also respond to three (3) additional components (Consolidated Plan Priorities, Impact on Affordable Housing Stock, Project Financing & Operating Budget) and complete the appropriate forms below: • Form 6: Development Project Summary • Form 7: Housing Blueprint & Consolidated

Plan Priority Needs & Non-Homeless Special Needs

• Form 8: Impact on Affordable Rental Housing Stock

• Form 9: Applicant Experience & Qualifications

• Form 10: Proposed Occupancy & Rent Schedules

• Form 11: Detailed Estimate of Development Costs

• Form 12: Detailed Estimate of Annual Operating Expenses

• Form 13: Project Costs & Financing • Form 14: Pro Forma

ATTACHMENTS Current Board of Director’s Roster (including

phone numbers and email addresses).

Program Position Descriptions including required skills, program management and fiscal staff positions. NOTE: Criminal background checks are required for individuals providing indirect or direct services within public schools, afterschool programs, etc. via state police and Child Protective Services. Employees working with other vulnerable populations (such as persons with disabilities, senior citizens, etc.) must also have criminal record checks.

Program staff resumes for key personnel assigned to work on the program.

Successful Applicants must submit, if available, unaudited financial statements for the month of October 31, 2017.

OR

The most recent financial audit and management letter that adheres to the required schedule of submitting the audit within (180) days after the end of Applicant’s fiscal year, prior to May 15, 2017. Successful applicants whose fiscal year ends June 30th must submit a financial audit and management letter, if available, for the period ending June 30, 2017. Successful applicants whose fiscal year ends December 31st must submit a financial audit and management letter for the period ending December 31, 2016. The audit for the period ending December 31, 2017 will be collected during contractual monitoring after the execution of the contract.

If you are a start-up organization and do not have an audit at the time of submission, please note this in the application and provide, in lieu of an audit and management letter, financial statements for the period ending October 31, 2017. If funded, the organization will be required to submit an audit following the first year of operation.

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2016 Federal Tax Form 990 (If not available, explainwhyandsubmitthemostrecentfiling.)

FiscalYear2017organization-widebudget CertificationofFinancialSolvency CertificationRegardingEthicsinPublic

Contracting CertificationRegardingDebarmentor

Suspension VirginiaStateCorporationCommission

(SCC)RegistrationInformationForm CooperativeAgreementorLetter(ifapplicable) MemorandumofAgreementorLetter

(ifapplicable) Newlyformedorganizationsmustsubmita

copyofthe501(c)3certificationorthe proposalfor501(c)3.

RENTAL HOUSING & CAPITAL PROJECTS ATTACHMENTS

• CostEstimatesforRehabilitationWork • Community-BasedDevelopmentOrganiz-

ation(CBDO)Checklist(page58of ResourceManual)

All form templates are available at: http://www.fairfaxcounty.gov/solicitation/. All addenda MUST be signed and MUST accompany the proposal.

2. PROPOSAL SUBMISSION: a. Allpagesoftheproposal(i.e.technicaland

cost,includingattachments),mustbenum-beredconsecutively(“1of30,”etc.).Techni-cal and cost proposals should be numbered separately. (Do not include promotional DVD’s or videos in your proposal submis-sion packet.)

Thereisnolimittothenumberofprogramrequestsanorganizationcansubmit.Eachpro-posalmustbesubmittedandpackagedsepa-ratelywithallrequestedformsandattachments.Applicantsarerequiredtosubmitone(1)original(dulymarked))printedcopyoftheirtechnicalandcostproposalsalongwithanexactelectron-iccopyonone(1)CD/USB.Thetechnicaland


cost proposals should be contained in separate anduniqueelectronicfilesontheCD/USB.TheApplicantmustalsoincludeanotarizedstate-mentthattheCD/USBversionisatruecopyoftheoriginal,printedversion.

b. Thecompletedtechnicalproposal,includ-ingrequiredformsandattachmentsforeachproposedprogram,istobescannedasonefileandcopiedtotheCD/USB.The“Cost”proposal,whichincludesthebudgetnarrativeandforms4,4A,4B,and5,and,ifapplicable,housingprojectsforms6-14,shouldbesubmittedonthesameCD/USBunderaseparatefileandlabeledaccording-ly.EachproposalsubmittedmustbeonaseparateCD/USB.Pleasechecktoensurethatbothfilesopenproperlyandthedocu-mentsarereadable.

TheCDs/USBsshouldbelabeledwiththeRFPnumber,aswellastheorganizationandprogramtitle.ProposalsandCDs/USBsshould be submitted in sealed envelopes or boxes.TheRFPnumber,Applicant’snameand address should be indicated on the out-sideofeachenvelopeorbox.Electronicallystampeddeliveryreceiptsareavailable.

c. Allfundingrequestsmustberoundeduptothenearestwholedollaramount.

d. Proposalsshouldbepreparedelectronicallyusingappropriatesoftwareapplications.Theproposal narrative, exclusive of requested forms and attachments, should not exceed fifteen(15),singlesided,8.5by11inchpagesandshouldbeinastandard12-pointfontorlarger,preferablyTimesNewRoman.Propos-al forms, attachments, and Table of Contents areexemptfromthepagelimitationcount.

e. Applicantsshouldnotusecolored,textured,heavyweight,ortabbedpaper.Inaddition,allattachments,originallypublishedorprintedontwosided,colorand/orglossypaper,shouldberecopiedonsingle8.5by11-inchwhitepaperforsubmissionintheproposal.

f. Proposalsmustbeheldtogetherwithpaper

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clips or rubber bands only. Staples, bind-ings,and notebooks are unacceptable.

g. Submissions by facsimile machine or via the Internet will not be accepted.

Each Applicant responding to this Request for Proposal must supply all the documentation required in the RFP including attachments. Failure to provide documentation with the Applicant’s response to the RFP will result in the disqualification of the proposal.

Proposals must be received no later than 2:00 p.m. on December 4, 2017, by the Fairfax County Department of Procurement and Material Management at 12000 Govern-ment Center Parkway, Suite 427, Fairfax, Virginia 22035.

Late proposals (after 2:00 p.m.) will not be accepted or considered for contract award, and will be returned to the applicant. A proposal with an unsigned Form 1, Proposal Cover Sheet may not be accepted.

3. FUNDING APPLICATION FORMS: The Proposal Narrative Form and Budget Forms

including the Resource Manual, which includes reference documents to assist you in the development of your proposal, are available for downloading on the DPMM website: http://www.fairfaxcounty.gov/solicitation/. The proposal forms and the Resource Manual are also available on the CCFP website: http://www.fairfaxcounty.gov/ccfp/.

4. LARGE PRINT VERSION: This RFP is available in large print typeface

through the Department of Administration for Human Services Contracts & Procurement Management by sending a request via email to

[email protected]. Please allow seven working days to process your request.

5. QUESTIONS: A Pre-Proposal Conference will be held on

October 26, 2017, at 1 P.M. in the Board of Supervisors Auditorium at the Fairfax Coun-ty Government Center, 12000 Government Center Parkway, Fairfax, Virginia 22035. The purpose of the Pre-Proposal Conference is to give potential Applicants an opportunity to ask questions and obtain clarification regarding any aspect of this RFP. Due to the importance of all Applicants having a clear understanding of the requirements of this solicitation, attendance at this conference is strongly encouraged. This will be the only conference held on this solicitation.

NOTE: Any changes to the request for proposal/questions & responses will be sent in the form of an addenda within five (5) days prior to the due date of the proposal. The final date to submit questions is November, 24, 2017, at 2:00 PM. All addenda MUST be signed and MUST accom-pany the proposal. The notice of addenda will be posted on eVA and the document itself will be posted on the DPMM current solicitation web-page. It is the Applicant’s responsibility to monitor the web page for the most current addenda at http://www.fairfaxcounty.gov/solicitation/.

This pre-proposal conference will be simulcast live on Cable Channel 16, the Fairfax County government television station. The pre-proposal conference can also be viewed via the Internet at: http://www.fairfaxcounty.gov/ccfp/ and click on the appropriate link.

All questions should be directed to Derek Solomon, Contract Specialist, Department of Procurement and Material Management via email at: [email protected].

http://www.fairfaxcounty.gov/solicitation

fairfaxcounty.gov/ccfp

mailto:[email protected]

http://www.fairfaxcounty.gov/solicitation

http://www.fairfaxcounty.gov/ccfp


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PROPOSAL CONTENT (A)

ALL PROPOSALS REQUESTING OVER $50,000 PER YEAR MUST COMPLY WITH THIS PROPOSAL CONTENT (A).

TECHNICAL SECTION: Applicants are requested to respond to the following:

PROPOSAL COVER SHEET:Proposal Cover Sheet (DPMM32) (Form 1) — Fill out completely. Applicant’s legally authorized representative MUST SIGN a Proposal Cover Sheet for each proposal submitted. Proposals without signed cover sheets may be deemed non- responsive and may not be considered for funding. If the proposal is submitted jointly by multiple orga-nizations, the Proposal Cover Sheet should identify one organization as the primary contact.

PROPOSAL NARRATIVE: Applicants are required to use the proposal narrative form for the technical section of the proposal. See page 11, for downloading instructions.

The Proposal Narrative Form (Form 2A) is required to respond to all sections included in the RFP which includes the Demonstration of Need, Outcomes, Approach, and Organizational Capacity. Affordable Housing Capital Projects must include a response to three additional components and appropriate forms. Include funding priorities that can best be met by the proposed program.

A. DEMONSTRATION OF NEED: Total = 15 Points

Proposal describes need to be addressed and relates it to no more than two Consolidated Community Funding Pool (CCFP) funding priorities on pages 5–7, Proposal Guidelines.

1. Provide specific information that justifies the need for the proposed program for the identi-fied neighborhoods, populations and/or other targeted geographic area(s) to be served.

Include relevant and current information about the population to be served. (8 points)

2. Describe the nature and scope of the prob-lem that the program will address (i.e., needs and gaps in services). Include current local statistical data (demonstrated within the past 3 years) or other objective evidence of the need. Demonstrate the size and scope of the need in Fairfax County and/or the targeted geographic area(s), and document the effects of the need on the target population and the larger commu-nity. Include any research or evaluation studies that relate to the problem and contribute to the Applicant’s understanding of its causes and potential solutions. (7 points)

B. OUTCOMES: Total = 25 Points

The proposal describes how program outcomes contribute to each selected CCFP Priority. The proposal explains how the selected standardized outcome(s) will be achieved. Proposal clearly identifies and describes one or more measurable program outcomes that are logically related to the identified need and program approach. The proposal demonstrates that there is a contributing relationship between each outcome and the program approach; and that each outcome will have a significant impact on the population and/or the targeted geographic area(s).

As part of the recommendations from the CCFP Review Steering Committee, applicants are required to select from a list of standardized program outcomes listed below. Applicants should select at least one of the standardized program outcomes and should, as applicable, include additional program outcomes that are relevant to their proposals. All standardized outcomes must be included on Form 3 of each proposal submitted.

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T his table is a guide that applicants should use to select standardized outcomes that best demon-strate the impact of program services.

• Persons feel better connected to the community as a result of participating in programs and services

• Children and youth have increased stability

• Adults have access to information and resources that promote stability

• Persons have improved basic English skills after completing English language instruction

• Persons obtain job skills

• Persons remain employed for at least 90 days after job placement

• Persons have improved financial management skills

• Persons have improved capacity to manage finances

• Adults have stable or improved physical health (Self-report/Professionally Assessed)

• Adults have stable or improved behavioral health (Self-report/Professionally Assessed)

• Youth attend school, graduate or receive a GED at program completion

• Individuals and/or families are successfully housed

1. Explain how the program plans to achieve the selected standardized outcome. If a standardized outcome was not selected, explain why none of the standardized outcomes align with the pro-posed program model and describe the proposed measurable outcome to be used. (6 points)

2. Describe how the outcome(s) will address the needs identified in the selected priority area(s) and how each outcome will have an impact on the population and/or community served. (7 points)

3. Describe how each outcome will be objectively measured. Provide supporting information demonstrating that the outcomes are realistic

and achievable within the identified timeframes. (6 points)

4. Describe the plan for outcome measurement implementation. Indicate how the data will be collected and maintained, including any assess-ment tools and/or data collection software to be used. (6 points)

Submit Form 3 (Program Outcome Worksheet) as an attachment for each significant outcome that shows how outcomes are clearly linked to the iden-tified problem and are achievable within each of the two fiscal years. Describe only one discreet service in each Form 3. Insert/ place Form(s) 3 after the outcome narrative.

STANDARDIZED PROGRAM OUTCOMES ARE AS FOLLOWS:

• Children and youth have stable or improved behav-ioral health (Self-report/Professionally Assessed)

• Persons have improved family functioning

• Persons have decreased levels of risk of abuse, neglect or exploitation

• Persons are able to plan for their safety as a result of gained skills, awareness, and knowledge

• Older Adults and Individuals with Disabilities have options that support their physical, behavioral, and cognitive needs

• Caregivers receive health and well-being benefits from support services

• Older Adults and Individuals with Disabilities participate in meaningful and accessible activities of their choice

• Children have a medical home

• Children reach benchmarks supporting school readiness

• Youth have improved academic performance

• Housing units are added or preserved

• Persons move into permanent housing and do not return to homelessness

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C. APPROACH Total = 20 Points

Proposal describes the strategies that will be implemented, operated and administered within a realistic time period; how it will be provided within a cooperative service delivery approach; and how readily targeted clients will access services.

1. Describe how each of the program services/ac-tivities will be organized, implemented and com-pleted to achieve the goals/objectives. Identify any major changes/challenges in the program that may affect the timeframe for service deliv-ery. (5 points)

2. Describe any anticipated limitations and barriers to client access to the services (i.e. transportation, language/culture, client fees, etc.). (3 points)

3. For programs awarded a CCFP contract in pre-vious funding cycles, describe how the program implemented its design to achieve service and outcome goals and explain how the approach contributed to the success of the program. If the proposed program is new to the Funding Pool or a startup program, submit a program timeline that displays major tasks, assigned responsibil-ity for each and outlines the completion of each task by month or quarter during the contract pe-riod, using “Year 1”, “Month 1”, “Quarter 1”, etc. (not calendar dates). Include any staff positions that will need to be filled after contract award and the projected hiring date. Examples of timelines can be found in the Resource Manual, page 49. (4 points)

4. If the proposal is an existing program, describe past performance. For new or startup programs, describe the level of success of a similar pro-gram. Include any statistical data that supports successful performance. (4 points)

5. Describe how other community groups/resourc-es will be used to maximize service delivery and minimize duplication. (4 points)

AFFORDABLE HOUSING CAPITAL PROJECTS must also provide the following when describing their approach:

6. Complete Form 6 — Development Project Summary

7. If the project requires temporary displace-ment, indicate the number of households and describe specific assistance to be provided to households temporarily displaced. Describe plans for compliance with federal Uniform Relocation Act regulations, including financial and other assistance to be provided, and the source(s) of such assistance.

(NOTE: Projects Requiring Permanent Relocation Will Not Be Considered.)

D. ORGANIZATIONAL CAPACITY Total = 20 Points

The proposal demonstrates the applicant’s organizational skills, experience and resources necessary to implement and manage the program. Two or more organizations may choose to submit a collaborative proposal.

1. Describe the program’s organizational structure and operations. The description should include management/staffing patterns connected to the program design and the roles/responsibilities of key program staff. Key program staff may either be paid or unpaid employees, consul-tants, contractors or volunteers. Roles and responsibilities must clearly connect to the program design. For organizations new to the CCFP, include organizational and/or program staff experience effectively implementing programs of similar design. (4 points)

2. Describe the work to be performed by pro-fessional and non-professional volunteers. The description should include the estimated number of professional and non-profession-al volunteers and the anticipated number of hours they will work each year. (Applicants should also include the number of professional and nonprofessional volunteers and the hours worked each year on the Form 5). (4 points)

3. Describe in detail how clients with disabilities will be accommodated to access program services and how the organization complies with the Americans with Disabilities Act (ADA) i.e. wheelchair accessible ramps, elevators, handicap rails etc. (4 points)

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NOTE: Fairfax County Government is fully committed to the ADA, which guarantees non- discrimination and equal access for persons with disabilities in employment, public accommodations, transportation, and all county programs, activities and services. Fairfax County Government contrac-tors, subcontractors, vendors, and/or suppliers are subject to this ADA policy. All individuals having any county contractual agreement must make the same commitment to comply with ADA. Acceptance of a contract acknowledges your commitment and com-pliance with ADA.

4. Describe the plans for fiscal accountability and management of the proposed program funding. Explain how CCFP funds will be tracked sepa-rately from other funding streams and any use of outside accounting and/or payroll services. (4 points)

5. Describe, in detail, plans to sustain the program during and beyond the CCFP funding period. This sustainability plan should describe the applicant’s ability to provide sufficient supporting resources to sustain and grow the program over and above county funding commitments. The plan should also include a demonstrated ability to increase program leveraging (all resources) from FY2019 to FY2020. (4 points)

NOTE: If awarded a contract, the applicant’s actual reported leverage, including the expected increase during FY2019 through FY2020, may be

considered in future evaluations of the program’s effectiveness.

AFFORDABLE HOUSING CAPITAL PROJECTS should also provide the following as part of their Organizational Capacity submission:

6. List the housing projects Applicant has undertaken over the last three years. Provide the following for each: project name, location, type of project (rental/homeownership), number of units, year started and completed, estimated cost, population served and affordability requirements.

a. Complete the Community-Based Development Organization (CBDO) Checklist found in the Resource Manual, page 58, if applicable, and place in form section.

b. If the Applicant is requesting funding for a new construction project, and currently does not meet all the CBDO requirements as indicated in 6a above, describe the nature and timing of steps Applicant has taken or will take to meet all the CBDO requirements. (Applicants recommended for funding will be required to submit the CBDO documentation indicated in the checklist before award or execution of a contract.)

c. Complete Form 9: Applicant Experience and Qualifications.

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the portion of the total budget to be funded by CCFP. Figures should reflect cash only and should not include non-cash resources.)

The budget must provide the detailed computation for each budget line item, listing the cost of each item. Figures should not include non-cash resources.

Describe and justify each budget line item using Form 4B, Budget Justification. The budget justification must explain how all estimated costs were calculated. Failure to adequately describe and justify each line item on Forms 4A and 4B will result in a loss of points. Personnel costs must show the annual salary rate and the percentage of time devoted to the program for each employee to be paid with CCFP funds. (10 points)

3. Estimated Program Revenue: Complete Form 5.

(NOTE: Estimated Revenue identifies additional resources other than county funds or county contributions that help support/sustain the program during and beyond the funding period. Cash resources include donations, grants, contracts and awards. Non-cash resources include volunteers, in-kind contributions and goods, supplies and service donations. Non-professional volunteers are to be valued at $26.96 per hour in accordance with the current Virginia Employment Commission established rate. The hourly value of a professional volunteer’s service is to be determined based upon the normal hourly rate charged by the professional volunteer for paid services. The hourly values must be justified in the written narrative.) (5 points)


COST SECTION:

Applicants are required to use the Budget Forms to respond to the following sections (see page 11 for downloading instructions):

E. BUDGET AND BUDGET JUSTIFICATION Total = 20 Points

Proposal presents a clear and reasonable program budget and identifies additional resources to sustain the program other than county funds or county contributions that can help support the proposed program. (Resources may include volunteers, in-kind contributions, cash donations, supplies and services, donations, grants and/or contracts.)

1. Provide a brief supporting narrative to link costs with program activities. Applicants should demonstrate in their budget narrative how they will maximize cost effectiveness of the requested funds. The budget should be complete and cost-effective in relation to the proposed activities. (5 points)

The narrative should explain how the Applicant estimated and calculated all costs, and how they are relevant to the completion of the proposed program. As with Form 4, 4A and 4B, the Budget Narrative should be broken down by year.

NOTE: Applicants are to disclose whether they have pending applications for other Fairfax County funds that include requests for funding to support the same program being proposed under this RFP to cover any of the cost items outlined in the budget narrative and budget forms. This also includes current contracts that cover any of the identified program costs.

2. Program Budget: Complete Form 4 and 4A.

(NOTE: “Total Program Budget” means the total cost of conducting the program in Fairfax County, CCFP funds requested included. “CCFP Budget Request” should reflect only

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The following items are applicable ONLY to AFFORDABLE HOUSING PROJECTS.

F. CONSOLIDATED PLAN PRIORITIES Total = 15 Points Proposal serves one or more of the priority house-hold populations identified in the Fairfax County Consolidated Plan: Fiscal Years 2016–2021. Very low income means 50% or less of the MSA Median Income. Extremely low income means 30% or less the MSA Median Income.

Complete Form 7: Housing Blueprint & Consolidated Plan Priority Needs & Non- Homeless Special Needs

Identify all priority populations to be served by the proposed housing, including (a) homeless families and individuals, (b) persons with disabilities, (c) low-income seniors, and/or (d) low-income working families. (15 points)

G. IMPACT ON AFFORDABLE HOUSING STOCK Total = 15 Points Proposed project produces new affordable units in an area with limited existing affordable housing and there is a documented market for proposed housing project; OR proposed project preserves and/or rehabilitates existing affordable units.

1. Identify the number and types of units to be created, acquired or preserved by this project. Describe the plans for maintaining and pre-serving the property after the project is com-pleted. (4 points)

2. Describe clearly the supportive services to be provided to the tenant and either the known community amenities and neighborhood resources to be available and accessible to the tenant(s) of the identified property for the project or the types of community amenities and neighborhood resources to be sought in selecting the property. (3 points)

3. Describe clearly the specific need for this project in the identified or targeted community and/or

Human Services Region and the applicability of federal fair housing laws and regulations to the site location. Include objective evidence of the current supply of affordable housing units for the population to be served and the demand for additional units of the type proposed. (3 points)

4. Describe your marketing plan for identifying and selecting eligible tenants for each unit, including the applicability of federal fair housing laws and regulations, and all source(s) of applicants, i.e. existing waiting lists, referrals from one or more other entities, advertisements or other sources. (5 points)

5. Complete Form 8: Impact on Affordable Housing Stock — (Attachment section)

H. PROJECT FINANCING & OPERATING BUDGET Total = 10 Points

Proposal provides evidence that proposed project financing, sources of financing and operating plans are feasible.

1. Complete Forms 11, 12, 13 and 14 for projects.

2. Demonstrate the feasibility of the project by budgeting for all project costs from start to finish and identifying sources of enough financ-ing for all project costs. In the budget narra-tive, explain the source(s) of the budget data, i.e., based on known actual costs for property already identified for this project, prior com-parable projects or budgets from comparable projects. If the budget is not based on known actual costs, identify the comparable project. (5 points)

3. Demonstrate the feasibility of the project by projecting an operating budget and five year pro forma for the completed project, including all sources of operating income and all project-ed expenses. In the budget narrative, explain the source(s) of the operating budget income/expense data projections. (5 points)

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PROPOSAL CONTENT (B)

PROPOSALS REQUESTING $50,000 OR LESS PER YEAR SHOULD COMPLY WITH THIS PROPOSAL CONTENT (B).

Forms 1 through 5 and all other instructions and attachments also

are required unless otherwise stated.

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APPLICANTS REQUESTING $50,000 OR LESS PER YEAR SHOULD RESPOND TO THE FOLLOWING:

TECHNICAL SECTION:

PROPOSAL COVER SHEET:Proposal Cover Sheet (DPMM32) (Form 1) — Fill out completely. Applicant’s legally authorized representative MUST SIGN a Proposal Cover Sheet for each proposal submitted. Proposals without signed cover sheets may be deemed non-respon-sive and may not be considered for funding. If the proposal is submitted jointly by multiple organiza-tions, one organization should be designated as the primary contact.

PROPOSAL NARRATIVE: Applicants are required to use the proposal narrative form for the technical section of the proposal. See page 11, for downloading instructions.

The Proposal Narrative Form (Form 2B) is required to respond to all sections included in the RFP which includes the Demonstration of Need, Outcomes, Approach, and Organizational Capacity. Include funding priorities that can best be met by the proposed program.


Proposal describes need to be addressed, targeted population and service area.

1. Describe the need, scope and the purpose of the proposal to address the problem as it relates

to the chosen priority area. Include current local statistical data (demonstrated within the past 3 years) or other objective evidence of the need and information that describes how the program will benefit the population to be served. Provide specific information for the identified popu-lations, neighborhoods and/or targeted geo-graphic area to be served. Include relevant and current information about the population to be served. Demographic information can be found at: http://www.fairfaxcounty.gov/government/about/data/ and http://huduser.org.

B. OUTCOMES: Total = 25 Points

Proposal clearly identifies and describes one or more measurable program outcomes that are logically related to the identified need and program approach. The proposal demonstrates that there is a contributing relationship between each outcome and the program approach; and that each outcome will have a significant impact on the population and/or the community affected by the identified need.

As part of the recommendations from the CCFP Re-view Steering Committee, applicants are required to select from a list of standardized program outcomes listed below. Applicants should select at least one of the standardized program outcomes and should, as applicable, include additional program outcomes that are relevant to their proposals. All standard-ized outcomes must be included on Form 3 of each proposal submitted.

http://www.fairfaxcounty.gov/government/about/data


http://huduser.org

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1. The proposal explains how the program plans to achieve the selected standardized mandato-ry outcome(s). If a standardized outcome was not selected, the proposal explains why none of the standardized outcomes align with the organization’s program model and proposes a possible outcome that would be suitable. (10 points)

2. The proposal describes how the standardized and/or agency developed outcomes will address

the identified needs in the selected priority area(s) and describes how outcome data will be measured, collected and maintained. (15 points)

Submit Form 3 (Program Outcome Worksheet) as an attachment for each significant outcome that shows how outcomes are achievable within each of the two fiscal years. Describe only one discreet service in each Form 3. Insert/place Form(s) 3 after the outcome narrative.


T his table is a guide that applicants should use to select standardized outcomes that best demon-strate the impact of program services.

• Persons feel better connected to the community as a result of participating in programs and services

• Children and youth have increased stability

• Adults have access to information and resources that promote stability

• Persons have improved basic English skills after completing English language instruction

• Persons obtain job skills

• Persons remain employed for at least 90 days after job placement

• Persons have improved financial management skills

• Persons have improved capacity to manage finances

• Adults have stable or improved physical health (Self-report/Professionally Assessed)

• Adults have stable or improved behavioral health (Self-report/Professionally Assessed)

• Youth attend school, graduate or receive a GED at program completion

• Individuals and/or families are successfully housed

STANDARDIZED PROGRAM OUTCOMES ARE AS FOLLOWS:

• Children and youth have stable or improved behav-ioral health (Self-report/Professionally Assessed)

• Persons have improved family functioning

• Persons have decreased levels of risk of abuse, neglect or exploitation

• Persons are able to plan for their safety as a result of gained skills, awareness, and knowledge

• Older Adults and Individuals with Disabilities have options that support their physical, behavioral, and cognitive needs

• Caregivers receive health and well-being benefits from support services

• Older Adults and Individuals with Disabilities participate in meaningful and accessible activities of their choice

• Children have a medical home

• Children reach benchmarks supporting school readiness

• Youth have improved academic performance

• Housing units are added or preserved

• Persons move into permanent housing and do not return to homelessness

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C. APPROACH TOTAL = 20 PointsProposal describes the strategies that will be implemented, operated and administered within a realistic time period; how it will be provided within a cooperative service delivery approach; and how readily targeted clients will access services.

1. Proposaldescribesspecificplanstoimplementtheservicestoachievethegoals/objectives,toincludehowothercommunitygroups/resourceswillbeusedtomaximizeservicedeliveryandminimizeduplication.(10points)

2. Proposaldescribesanyanticipatedlimitationsandbarrierstoclientaccesstotheservices(i.e.transportation,language/culture,clientfees,etc.).(5points)

3. ForprogramsawardedaCCFPcontractinpreviouscycles,theproposaldescribeshowtheprogramwassuccessfulinimplementingitsdesignandprovidedetailsofpastperformance.

OR IftheproposedprogramisnewtotheFunding

Poolorastartupprogram,theproposalincludesaprogramtimelinethatdisplaysmajortasks,assignedresponsibilityforeachandoutlinesthecompletionofeachtaskbymonthorquarterduringthecontractperiodusing“Year1”,“Month1”,“Quarter1”,etc.(notcalendardates).(5points)

D. ORGANIZATIONAL CAPACITY TOTAL = 20 Points

The proposal demonstrates the applicant’s orga-nizational skills, experience and resources neces-sary to implement and manage the program. Two or more organizations may choose to submit a collaborative proposal.

1. Describetheprogram’sorganizationalstructureandoperations.Thedescriptionshouldincludemanagement/staffingpatternsconnectedtotheprogramdesignandtheroles/responsibilitiesofkeyprogramstaff.Keyprogramstaffmayeitherbepaidorunpaidemployees,consultants,con-tractorsorvolunteers.Rolesandresponsibilitiesmustclearlyconnecttotheprogramdesign. FororganizationsnewtotheCCFP,includeorganizationaland/orprogramstaffexperience

effectivelyimplementingprogramsofsimilardesign.(5points)

2. Describetheworktobeperformedbyprofes-sionalandnon-professionalvolunteers.Thede-scriptionshouldincludetheestimatednumberofprofessionalandnon-professionalvolunteersandtheanticipatednumberofhourstheywillworkeachyear.(ApplicantsshouldalsoincludethenumberofprofessionalandnonprofessionalvolunteersandthehoursworkedeachyearontheForm5)(4points)

3. Describeindetailhowclientswithdisabilitieswillbeaccommodatedtoaccessprogramser-vicesandhowtheorganizationcomplieswiththeAmericanswithDisabilitiesAct(ADA)i.e.wheelchairaccessibleramps,elevators,handi-caprails,etc.(4points)

NOTE:FairfaxCountyGovernmentisfullycommittedtotheAmericanswithDisabilitiesAct(ADA)whichguaranteesnon-discriminationandequalaccessforpersonswithdisabilitiesinemployment,publicaccommodations,transpor-tation,andallcountyprograms,activitiesandservices.FairfaxCountygovernmentcontrac-tors,subcontractors,vendors,and/orsuppliersaresubjecttothisADApolicy.AllindividualshavinganycountycontractualagreementmustmakethesamecommitmenttocomplywithADA.AcceptanceofacontractacknowledgesyourcommitmentandcompliancewithADA.

4. Describetheprogram’sfiscalmanagementsystemandanyuseofoutsideaccountingand/orpayrollservices.ExplainhowCCFPfundswillbetrackedseparatelyfromotherfundingstreams.(7points)

Describe,indetail,planstosustaintheprogramduringandbeyondtheCCFPfundingperiod.Thissustainabilityplanshoulddescribetheap-plicant’sabilitytoprovidesufficientsupportingresourcestosustainandgrowtheprogramoverandabovecountyfundingcommitments.Theplanshouldalsoincludeademonstratedabilitytoincreaseprogramleveraging(allresources)fromFY2019toFY2020.

NOTE:Ifawardedacontract,theapplicant’sactualreportedleverage,includingtheexpect-edincreaseduringFY2019throughFY2020,maybeconsideredinfutureevaluationsoftheprogram’seffectiveness.


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COST SECTION:

Applicants are required to use the Budget Forms to respond to the following sections (see page 11 for downloading instructions):

E. BUDGET NARRATIVE AND BUDGET JUSTIFICATION Total = 20 Points

Proposal presents a clear and reasonable program budget and identifies additional resources to sustain the program other than county funds or county contributions that can help support the proposed program. (Resources may include volunteers, in-kind contributions, cash donations, supplies and services, donations, grants and/or contracts.)

1. Describe and justify each budget line item using Form 4, 4A and Form 4B, Budget Justifica-tion. Failure to adequately describe and justify each line item on Forms 4A and 4B will result in a loss of points. Personnel costs must show the annual salary rate and the percentage of time devoted to the program for each employee paid through CCFP funds. (10 points)

(NOTE: “Total Program Budget” means the

total cost of conducting the program in Fairfax County, CCFP funds requested included. “CCFP Budget Request” should reflect the portion of the total budget to be funded by CCFP only. Figures should reflect cash only and should not include non-cash resources).


2. Proposal includes completed Form 5 and iden-tifies additional resources that will support and sustain the program during and beyond the fund-ing period, including the use of volunteers, in-kind contributions, goods, supplies, etc. (10 points)


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PROPOSAL CONTENT

The next section consists of applicable forms that must be submitted with your proposal.

PLEASE NOTE THAT:FORMS 1 THROUGH 5 must be completed by ALL Applicants.

(Applicants requesting under $50,000 per year, use Form 2-B.)

FORMS 6 THROUGH 14 must be completed by Affordable Housing Capital Project Applicants ONLY.

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Organization Name: __________________________________

Address: ___________________________________________

City, State, Zip: ______________________________________

Program Title: _______________________________________

FUNDING REQUEST:

FY 2019 $ __________________ FY 2020 $ __________________

Identify if proposal(s) is being submitted in collaboration with other nonprofit organization(s): ❑ YES ❑ NO

List Other Organization(s) by Name: ______________________

________________________________________________

FORM 1

FAIRFAXCOUNTY

DEPARTMENT OF PROCUREMENT & MATERIAL MANAGEMENT

12000 Government Center Parkway, Suite 427Fairfax, Virginia 22035-0013

www.fairfaxcounty.gov/dpmmTelephone: 703-324-3201 • FAX: 703-324-3228 • TTY: 711

Contact Person: _______________________________

Telephone: (_________) ________________________

Fax: (_________) _____________________________

E-mail: _____________________________________

Federal Tax ID #: ______________________________

Date Incorporated: _____________________________

State Corporation Commission ID #: _______________

Fairfax County Consolidated Community Funding PoolFiscal Years 2019–2020

PROPOSAL COVER SHEETPROPOSALS — In accordance with the following and in compliance with all terms and conditions, unless otherwise noted, the undersigned offers and agrees, if the proposal is accepted, to furnish items or services for which prices are quoted, at the price set opposite each item, delivered or furnished to designated points within the time specified. It is understood and agreed that with respect to all terms and conditions accepted by Fairfax County the items or services offered and accompanying attachments shall constitute a contract.

NOTE: Fairfax County does not discriminate against faith organizations in accordance with the Code of Virginia, § 2.2-4343.1 or against a bidder or Applicant because of race, religion, color, sex, national origin, age, disability, or any other basis prohibited by state law relating to discrimination in employment in the performance of its procurement activity.

By signing this proposal, Applicant certifies, acknowledges, understands, and agrees to be bound by the conditions set forth in the General Conditions and Instructions to Bidders as described in Appendix A, the Certification Regarding Ethics in Public Contracting set forth in Appendix B, and by any other relevant certifications set forth in Attachment 2.

Vendor Legally Authorized Signature:____________________________________________________ Date:___________________

Print Name and Title:_______________________________________________________________________________________

Sealed proposals subject to terms and conditions of this Request for Proposal will be received by the Fairfax County Purchasing Agent at 12000 Government Center Parkway, Suite 427, Fairfax, Virginia 22035-0013 until the date/time specified above. AN EQUAL OPPORTUNITY PURCHASING ORGANIZATION p

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Issue Date: Request for Proposal: For: Consolidated CommunityOctober 2, 2017 RFP# 2000002372 Funding PoolDepartment: Dept. of Administration Due Date: Contract Administrator: for Human Services & Dept. of December 4, 2017 Derek Solomon @703-324-3603; Housing and Community Development @ 2:00 PM [email protected]

www.fairfaxcounty.gov/dpsm


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FORM 2–A

FairFax County Consolidated Community Funding Pool aPPliCation

fiscal years 2019–2020 PROPOSAL NARRATIVE FORM 1. Program Title: _____________________________________________________________________

2. Organization Name: ________________________________________________________________

3. Funding Request: FY 2019 $ _______________ FY 2020 $ _______________

4. 501(c)3 Certification ❑ Yes ❑ No; if no, date applied for 501(c)3 Certification

5. FUNDING PRIORITY: Choose no more than two (2) priority areas and identify the percent of CCFP funding request allocated to each. (See page 5–7, Proposal Guidelines.) Percent of CCFP Funding Request HOUSING Outcome: Families and individuals of all ages and abilities — including those at risk of homelessness, people with disabilities, older adults and individuals in the local workforce — can afford safe, stable, healthy and accessible living accommodations along with other basic necessities and will have access to affordable, accessible housing with the supportive services necessary to live as independently as possible in a community setting. _______________

LITERACY/EDUCATIONAL DEVELOPMENT/ATTAINMENT Outcome: Families and individuals of all ages and abilities will have the ability to read, write and speak English effectively, manage finances, and attain employment goals through academic and vocational achievement. Children and youth will have access to quality early care and education and supports to develop employment and independent living skills. _______________

FINANCIAL STABILITY (Financial Assistance to Financial Empowerment) Outcome: Families, individuals of all ages and abilities will have the ability to possess and maintain sufficient income to consistently meet their basic needs — with no or minimal financial assistance or subsidies from private or public organizations. _______________

. HEALTH Outcome: Families and individuals of all ages and abilities will have access to primary, specialty, oral, and behavioral, and long term health care, particularly prevention services. Families and individuals of all ages and abilities will develop the knowledge and resources to practice healthy behaviors and to take action to prevent and manage disease and adverse health conditions. Children will have access to supplemental food year-round, seven days a week. _______________

SUPPORT/COMMUNITY/SOCIAL NETWORKS Outcome: Families and individuals of all ages, abilities, and income levels will have access to local services, including community- based transportation and childcare and the ability to establish and maintain communal and social relationships. _______________

TOTAL 100% 6. Provide a brief program abstract that summarizes the proposed program’s goals and objectives. ______________________________________________________________________________________

______________________________________________________________________________________Please refer to the Resource Manual for CSBG and CDBG income guidelines to determine the percentage of clients to be served in these categories.

7. Of the clients served, estimate the percentage that meets the Community Services Block Grant (CSBG) income level (125% of poverty). See page 39 of the Resource Manual. ❑ 8. Of the clients served, estimate the percentage that meets the Community Development Block Grant (CDBG) income levels (extremely low, low, low/moderate). See page 59 of the Resource Manual. ❑

9. Please check the appropriate box: ❑ New Program ❑ Currently funded through CCFP

10. PROGRAM TYPE: (Please check one) a. Human Service Program (Non Capital) ......................................................................❑ b. Affordable Housing Capital Project .............................................................................❑ c. Administration of Affordable Housing Capital Project .................................................❑

11. HUMAN SERVICE REGIONS: In what region(s) do the majority of the clients to be served reside? Please check all that apply; see Resource Manual for map.

region 1 ❑ region 2 ❑ region 3 ❑ region 4 ❑MU

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FORM 2–A (CONTINUED)

A. DEMONSTRATION OF NEED: Total = 15 Points 1. Provide specific information that justifies the need for the proposed program for the identified neighborhoods, populations and/or targeted geographic area to be served. Include relevant and current information about the population to be served. (8 points)

2. Describe the nature and scope of the problem that the program will address (i.e., needs and gaps in services). Include current local statistical data (demonstrated within the past 3 years) or other objective evidence of the need. Demonstrate the size and scope of the need in Fairfax County and/or the targeted geographic area(s), and document the effects of the need on the target population and the larger community. Include any research or evaluation studies that relate to the problem and contribute to the Applicant’s understanding of its causes and potential solutions. (7 points)

B. OUTCOMES: Total = 25 Points 1. Explain how the program plans to achieve the selected standardized outcome. If a standardized outcome was not selected, explain why none of the standardized outcomes align with the proposed program model and describe the proposed measurable outcome to be used. (6 points)

2. Describe how the outcome(s) will address the needs identified in the selected priority area(s) and how each outcome will have an impact on the population and/or community served. (7 points).

3. Describe how each outcome will be objectively measured. Provide supporting information demonstrating that the outcomes are realistic and achievable within the identified timeframes. (6 points)

4. Describe the plan for outcome measurement implementation. Indicate how the data will be collected and maintained, including information on assessment tools and/or data collection software to be used. (6 points)

PROPOSAL NARRATIVE — PROPOSAL CONTENT A

C. APPROACH: Total = 20 Points 1. Describe how each of the program services/

activities will be organized, implemented and completed to achieve the goals/objectives. Identify any major changes/challenges in the program that may affect the timeframe for service delivery. (5 points)

2. Describe any anticipated limitations and barriers to client access to the services (i.e. transportation, language/culture, client fees, etc.). (3 points)

3. For programs awarded a CCFP contract in previous funding cycles, describe how the program implemented its design to achieve service and outcome goals and explain how the approach contributed to the success of the program. If the proposed program is new to the Funding Pool or a startup program, submit a program timeline that displays major tasks, assigned responsibility for each and outlines the completion of each task by month or quarter during the contract period, using “Year 1”, “Month 1”, “Quarter 1”, etc. (not calendar dates). Include any staff positions that will need to be filled after contract award and the projected hiring date. Examples of timelines can be found in the Resource Manual, page 49. (4 points)

4. If the proposal is an existing program, describe past performance. For new or startup programs, describe the level of success of a similar program. Include any statistical data that supports successful performance. (4 points)

5. Describe how other community groups/resources will be used to maximize service delivery and minimize duplication. (4 points)

D. ORGANIZATIONAL CAPACITY: Total = 20 Points

1. Describe the program’s organizational structure and operations. The description should include management/staffing patterns connected to the program design and the roles/responsibilities of key program staff. Key program staff may either be paid or unpaid employees, consultants,

continued on next page

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contractors or volunteers. Roles and responsibilities must clearly connect to the program design. For organizations new to the CCFP, include organizational and/or program staff experience effectively implementing programs of similar design. (4 points)

2. Describe the work to be performed by professional and non-professional volunteers. The description should include the estimated number of professional and non-professional volunteers and the anticipated number of hours they will work each year. (Applicants should also include the number of professional and non-professional volunteers and the hours worked each year on Form 5). (4 points)

3. Describe in detail how clients with disabilities will be accommodated to access program services and how the organization complies with the Americans with Disabilities ACT (ADA) i.e. wheelchair accessible ramps, elevators, handicap rails, etc. (4 points)

4. Describe the plans for fiscal accountability and management of the proposed program funding. Explain how CCFP funds will be tracked separately from other funding streams and any use of outside accounting and/or payroll services. (4 points)

5. Describe, in detail, plans to sustain the program during and beyond the funding period. This sustainability plan should describe the Applicant’s ability to provide sufficient supporting resources to sustain and grow the program over and above county funding commitments. The plan should also include a demonstrated ability to increase program leveraging (all resources) from FY2019 to FY2020. (4 points)

E. BUDGET AND BUDGET JUSTIFICATION: Total = 20 Points

1. Provide a brief supporting narrative to link costs with project activities. Applicants should demonstrate in their budget narrative how they will maximize cost effectiveness of the requested funds. The budget should be complete and cost-effective in relation to the proposed activities. (5 points)

The narrative should explain how the Applicant

estimated and calculated all costs, and how they are relevant to the completion of the proposed program. As with the Form 4, 4A and 4B, the Budget Narrative should be broken down by year.

Applicants are to disclose whether they have pending applications for other Fairfax County funds that include requests for funding to support the same program being proposed under this RFP and will cover the identical cost items outlined in the budget narrative and budget forms in the application. This also includes current contracts that may have duplicative program costs. CCFP seeks this information to help avoid any unacceptable duplication of funding.

2. Program Budget: Complete Form 4 and 4A. The budget must provide the detailed computation for each budget line item, listing the cost of each item. Figures should reflect cash only and should not include non-cash resources. (10 points)

Describe and justify each budget line item using Form 4B, Budget Justification. The budget justification must explain how all estimated costs were calculated. Failure to adequately describe and justify each line item on Forms 4A and 4B will result in a loss of points. Personnel costs must show the annual salary rate and the percentage of time devoted to the program for each employee paid through CCFP funds.

3. Estimated Program Revenue: Complete Form 5: (NOTE: Estimated Revenue identifies additional resources other than county funds or county contributions that help support/sustain the program during and beyond the funding period. Cash resources include donations, grants, contracts and awards. Non-cash resources include volunteers, in-kind contributions and goods, supplies and service donations. Non-professional volunteers are to be valued at $26.96 per hour in accordance with the current Virginia Employment Commission established rate. The hourly value of a professional volunteer’s service is to be determined based upon the normal hourly rate charged by the professional volunteer for paid services. The hourly values must be justified in the written narrative.) (5 points)

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FairFax County Consolidated Community Funding Pool aPPliCation

fiscal years 2019–2020 PROPOSAL NARRATIVE FORM 1. Program Title: _____________________________________________________________________

2. Organization Name: ________________________________________________________________

3. Funding Request: FY 2019 $ _______________ FY 2020 $ _______________

4. 501(c)3 Certification ❑ Yes ❑ If no, date applied for 501(c)3 Certification ____________________

5. FUNDING PRIORITY: Choose no more than two (2) priority areas and identify the percent of CCFP funding request allocated to each. (See page 5–7, Proposal Guidelines.) Percent of CCFP Funding Request HOUSING Outcome: Families and individuals of all ages and abilities — including those at risk of homelessness, people with disabilities, older adults and individuals in the local workforce — can afford safe, stable, healthy and accessible living accommodations along with other basic necessities and will have access to affordable, accessible housing with the supportive services necessary to live as independently as possible in a community setting. _______________

LITERACY/EDUCATIONAL DEVELOPMENT/ATTAINMENT Outcome: Families and individuals of all ages and abilities will have the ability to read, write and speak English effectively, manage finances, and attain employment goals through academic and vocational achievement. Children and youth will have access to quality early care and education and supports to develop employment and independent living skills. _______________

FINANCIAL STABILITY (Financial Assistance to Financial Empowerment) Outcome: Families, individuals of all ages and abilities will have the ability to possess and maintain sufficient income to consistently meet their basic needs — with no or minimal financial assistance or subsidies from private or public organizations. _______________

. HEALTH Outcome: Families and individuals of all ages and abilities will have access to primary, specialty, oral, and behavioral, and long term health care, particularly prevention services. Families and individuals of all ages and abilities will develop the knowledge and resources to practice healthy behaviors and to take action to prevent and manage disease and adverse health conditions. Children will have access to supplemental food year-round, seven days a week. _______________

SUPPORT/COMMUNITY/SOCIAL NETWORKS Outcome: Families and individuals of all ages, abilities, and income levels will have access to local services, including community- based transportation and childcare and the ability to establish and maintain communal and social relationships. _______________

TOTAL 100% 6. Provide a brief abstract that summarizes the proposed program’s goals and objectives. ______________________________________________________________________________________

______________________________________________________________________________________Please refer to the Resource Manual for CSBG and CDBG income guidelines to determine the percentage of clients to be served in these categories.

7. Of the clients served, estimate the percentage that meets the Community Services Block Grant (CSBG) income level (125% of poverty). See page 39 of the Resource Manual. ❑ 8. Of the clients served, estimate the percentage that meets the Community Development Block Grant (CDBG) income levels (extremely low, low, low/moderate). See page 59 of the Resource Manual. ❑

9. Please check the appropriate box: ❑ New Program ❑ Currently funded through CCFP

10. PROGRAM TYPE: (Please check one) a. Human Service Program (Non-Capital) ......................................................................❑ b. Affordable Housing Capital Project .............................................................................❑ c. Administration of Affordable Housing Capital Project .................................................❑

11. HUMAN SERVICE REGIONS: In what region(s) do the majority of the clients to be served reside? Please check all that apply; see Resource Manual for map.

region 1 ❑ region 2 ❑ region 3 ❑ region 4 ❑

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1. Describe the need, scope and the purpose of the proposal to address the problem as it relates to the chosen priority area. Include current local statistical data (demonstrated within the past 3 years) or other objective evidence of the need and information that describes how the program will benefit the population to be served. Provide specific information for the identified populations, neighborhoods and/or targeted geographic area to be served. Include relevant and current information about the population to be served. Demographic information can be found at: http://www.fairfaxcounty.gov/government/about/data/ and http://huduser.org.

B. OUTCOMES: Total = 25 Points 1. The proposal explains how the program plans

to achieve the selected standardized out-come(s). If a standardized outcome was not selected, the proposal explains why none of the standardized outcomes align with the organization’s program model and proposes a possible outcome that would be suitable. (10 points)

2. The proposal describes how the standardized and/or agency developed outcomes will address the identified needs in the selected priority area(s) and describes how outcome data will be measured, collected and maintained. (15 points)

C. APPROACH: Total = 20 Points 1. Proposal describes specific plans to implement

the services to achieve the goals/objectives, to include how other community groups/resources will be used to maximize service delivery and minimize duplication. (10 points)

2. Proposal describes any anticipated limitations and barriers to client access to the services (i.e. transportation, language/culture, client fees, etc.). (5 points)

PROPOSAL NARRATIVE B3. For programs awarded a CCFP contract in

previous cycles, the proposal describes how the program was successful in implementing its design and provides details of past performance.

OR If the proposed program is new to the Funding

Pool or a startup program, the proposal in-cludes a program timeline that displays major tasks, assigned responsibility for each and out-lines the completion of each task by month or quarter during the contract period using “Year 1”, “Month 1”, “Quarter 1”, etc. (not calendar dates). (5 points)

D. ORGANIZATIONAL CAPACITY: Total = 20 Points

1. Describe the program’s organizational structure and operations. The description should include management/staffing patterns connected to the program design and the roles/responsibilities of key program staff. Key program staff may either be paid or unpaid employees, consultants, contractors or volunteers. Roles and responsibilities must clearly connect to the program design. For organizations new to the CCFP, include organizational and/or program staff experience effectively implementing programs of similar design. (5 points)

2. Describe the work to be performed by professional and non-professional volunteers. The description should include the estimated number of professional and non-professional volunteers and the anticipated number of hours they will work each year. (Applicants should also include the number of professional and non-professional volunteers and the hours worked each year on Form 5). (4 points)

3. Describe in detail how clients with disabilities will be accommodated to access program services and how the organization complies with the Americans with Disabilities Act (ADA) i.e. wheelchair accessible ramps, elevators, handicap rails, etc. (4 points)

continued on next page



http://huduser.org

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FORM 2–B (CONTINUED)

4. Describe the program’s fiscal management system and any use of outside accounting and/or payroll services. Explain how CCFP funds will be tracked separately from other funding streams. (7 points)

Describe, in detail, plans to sustain the program during and beyond the CCFP funding period. This sustainability plan should describe the applicant’s ability to provide sufficient supporting resources to sustain and grow the program over and above county funding commitments. The plan should also include a demonstrated ability to increase program leveraging (all resources) from FY2019 to FY2020.

NOTE: If awarded a contract, the applicant’s actual reported leverage, including the expected increase during FY2019 through FY2020, may be considered in future evaluations of the program’s effectiveness.

E. BUDGET AND BUDGET JUSTIFICATION: Total = 20 Points

1. Describe and justify each budget line item using Form 4, 4A and 4B, Budget Justification. Failure to adequately describe and justify each line item on Forms 4A and 4B will result in a loss of points. Personnel costs must show the annual salary rate and the percentage of time devoted to the program for each employee paid through CCFP funds. (10 points)


2. Proposal includes completed Form 5 and identifies additional resources that will support and sustain the program during and beyond the funding period, including the use of volunteers, in-kind contributions, goods, supplies, etc. (10 points)

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FORM 4

FairFax County Consolidated Community Funding Pool aPPliCation FisCal years 2019–2020

PROGRAM BUDGETPROGRAM: _________________________________________ ORGANIZATION:_____________________________________

BUDGET ACTUAL FISCAL YEAR FISCAL YEAR FISCAL YEAR 2018 2019 2020

TOTAL PROGRAM CURRENT CCFP TOTAL PROGRAM CCFP TOTAL PROGRAM CCFP BUDGET SUPPORT BUDGET BUDGET REQUEST BUDGET BUDGET REQUEST

a. Personnel Costs

Fringe Benefits

Payroll Taxes

TOTAL PERSONNEL

B. direCt Costs

Rent/Mortgage

Space Utilities/Maintenance

Audit

Financial Services

Consultants

Insurance

Equipment Purchase/Lease

Supplies

Telecommunications

Printing/Copying

Postage

Training

Travel

Direct Assistance

Software Purchase/License

Other (Explain in Form 4B)

C. Indirect Expenses

Management & General

Other Indirect Costs (Infrastructure)*d. Capital Expenses

Hardware Purchases

Equipment Purchases

Other Capital Costs

e. Housing Capital Costs

Rehabilitation

Acquisition

Construction

TOTAL DIRECT COSTS

TOTAL BUDGET____________________

NOTE: “Total Program Budget” means the total cost of conducting that program in Fairfax County, CCFP funds requested included. “CCFP Budget Request” should reflect the portion of the total budget to be funded by CCFP only.*See Resource Manual for definition.

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BUDGET

ACTUAL FISCAL YEAR FISCAL YEAR FISCAL YEAR 2018 2019 2020

TOTAL CURRENT TOTAL CCFP TOTAL CCFP PROGRAM CCFP PROGRAM BUDGET PROGRAM BUDGET BUDGET SUPPORT BUDGET REQUEST BUDGET REQUEST

PERSONNEL COSTS

Fringe Benefits

Payroll Taxes

TOTAL PERSONNEL

PROGRAM PERSONNEL BUDGET JUSTIFICATION

Briefly describe how the proposed position will support the CCFP program and

identify the number of hours per week spent on the specific program.

Provide detail on how fringe benefits and payroll taxes were calculated.


PROGRAM PERSONNEL BUDGETPROGRAM: _________________________________________ ORGANIZATION:_____________________________________

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FORM 4B

BUDGET

FISCAL YEAR FISCAL YEAR 2019 2020

CCFP BUDGET CCFP BUDGET REQUEST REQUEST

B. direCt Costs

Rent/Mortgage

Space Utilities/Maintenance

Audit

Financial Services

Consultants

Insurance

Equipment Purchase/Lease

Supplies

Telecommunications

Printing/Copying

Postage

Training

Travel

Direct Assistance

Software Purchase/License

Other (Explain)

C. Indirect Expenses

Management & General

Other Indirect Costs (Infrastructure)*

d. Capital Expenses

Hardware Purchases

Equipment Purchases

Other Capital Costs

e. Housing Capital Costs

Rehabilitation

Acquisition

Construction

TOTAL DIRECT COSTS

TOTAL BUDGET

BUDGET JUSTIFICATION Explain and justify each proposed budget line item for which CCFP

funds are being requested. The justification must relate the proposed line item to the appropriate project activity. Increases in requests

from 2019 to 2020 must be explained. Failure to provide a detailed justification may result in a significant loss of points.


PROGRAM BUDGET JUSTIFICATIONPROGRAM: _________________________________________ ORGANIZATION:_____________________________________

____________________

1) If the program is currently being funded by a resource other than CCFP, explain why CCFP funds are needed. If funded in the previous cycle and the amount requested represents a substantial increase (over 5%), please justify the requested increase in funds.

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FORM 5


ESTIMATED PROGRAM REVENUE(EXCLUDING CONSOLIDATED COMMUNITY FUNDING P\UNDS)

PROGRAM: _________________________________________ ORGANIZATION:_____________________________________

RESOURCE FY 2018 FY 2019 FY 2020 RESOURCE(List each resource by name) STATUS

Cash Resource

Federal

State

County (Non-CCFP)

United Way

Foundations

Fund Raising/Donations

Client Payments

Financing/Loans

Other

TOTAL

Non-Cash Resource

Donations

Space

Other

TOTAL

Volunteers

Number of Professionals

Number of Professional Hours

Value of Volunteer Hours

Number of Non-Professionals

Number of Non-Professional Hours

Value of Volunteer Hours ($26.96/hr.)

TOTAL PROGRAM REVENUE

Percent of Total Budget as Presented on Form 4 % % %

RESOURCE JUSTIFICATIONBriefly describe each proposed leveraged resource. Identify whether the resource will be used specifically for this program or shared between other agency pro-grams. If not committed, when is the resource projected to be obtained.

RESOURCE JUSTIFICATION: Explain how the value of non-cash resources was determined. If not committed, when is the resource projected to be obtained? Include a description of any space if provided in-kind and its estimated value.

RESOURCE JUSTIFICATION: Briefly describe the functions to be performed by volunteers supporting this program. Non-professional volunteers are to be valued at $26.96 per hour in accordance with the Virginia Employment Commission. Professional volunteers’ hourly value is to be determined by the Applicant and justified below.

24.90/hr

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FORM 6

1. PROJECT ADDRESS: ____________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

2. PROJECT LOCATION: ____________________________________________________________________

______________________________________________________________________________________________

3. NUMBER OF UNITS:______________________________________________________________________

4. TYPE OF UNITS: (single family, townhouse, condominiums, etc.) ________________________

_______________________________________________________________________________

5. TYPE OF DEVELOPMENT:

❑ Acquisition ❑ Rehabilitation Only ❑ Acquisition & Rehabilitation

6. IF EXISTING, YEAR PROJECT BUILT: _________________________________________________

7. PROJECT DEVELOPMENT TEAM MEMBERS:

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________ ______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________


AFFORDABLE RENTAL HOUSING CAPITAL PROJECTS DEVELOPMENT PROJECT SUMMARY

PROJECT: __________________________________________ ORGANIZATION:_____________________________________

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FORM 7

Indicate the number of households to be served on the following chart for each category of the Housing Blueprint Greatest Need. Include the total number (#) of households below for each of the Consolidated Plan Priority Unmet Needs and Non-Homeless Unmet Special Needs. Indicate grand total of households for all four Housing Blueprint categories.


AFFORDABLE RENTAL HOUSING CAPITAL PROJECTS Housing Blueprint & Consolidated Plan Priority Needs

& Non-Homeless Special Needs


HOUSING BLUEPRINT CONSOLIDATED PLAN PRIORITY UNMET NEEDS NUMBER OF GREATEST NEED AND NON-HOMELESS UNMET SPECIAL NEEDS HOUSEHOLDS SERVED (categories not mutually exclusive)

LOW INCOME • Elderly persons (aged 62-74 with <80% MFI with a mobility or # ____________________ SENIORS self-care limitation and at least one housing problem) • Frail elderly persons (aged 75+ with <80% MFI with a mobility # ____________________ or self-care limitation and at least one housing problem) TOTAL:

INDIVIDUALS or • Victims of Domestic Violence FAMILIES who (those who sought shelter) # ____________________ are HOMELESS

TOTAL:

PERSONS • Households with severe cost burden or those paying over WITH LOW AND 50% of their income for housing. These severely cost burdened # ____________________ EXTREMELY households are vulnerable to bankruptcy, homelessness LOW INC0MES and foreclosure.

TOTAL:

GRAND TOTAL IN ALL AREAS:

PERSONS • Persons with severe mental illness and alcohol and substance # ____________________ WITH abuse addiction DISABILITIES • Persons with intellectual disabilities # ____________________

• Persons with physical disabilities (<80% MFI income with a mobility of self-care limitation, includes elderly/frail elderly and # ____________________ also includes some persons with mental disabilities)* • Persons with HIV/AIDS and their families # ____________________

TOTAL:

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AFFORDABLE RENTAL HOUSING CAPITAL PROJECTS IMPACT ON AFFORDABLE RENTAL HOUSING STOCK


FORM 8

COMPLETE THE FOLLOWING, AS APPLICABLE TO PROPOSED PROJECTS:

A. Project produces new affordable units in an area with (Check One):

❑ a moderate number of affordable units

❑ few existing affordable units

1. Estimated total number of existing housing units in area _____________________________

2. Estimated total number of existing affordable housing units in area ____________________

3. Estimated total number of new affordable rental housing units to be added by the project ____________________________________

4. Source of information for 1–2 above ______________________________________________

B. Project preserves and/or rehabilitates existing affordable rental units? Yes ❑ No ❑

1. Identify age of housing units to be preserved and/or rehabilitated: _______________________

2. Identify the condition of the housing units to be preserved and/or rehabilitated (Check One):

❑ Minor rehabilitation required (total rehabilitation costs below $25,000 per unit)

❑ Substantial rehabilitation required (total rehabilitation costs $25,000 or more per unit)

3. Provide below, other information relevant to the condition of the units:

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FORM 9

Number of years organization in operation: _______________ Date Incorporated: _______________________

Number of years organization in housing development: __________________


AFFORDABLE HOUSING CAPITAL PROJECTS APPLICANT EXPERIENCE AND QUALIFICATIONS


1. Total number of units produced: ____________________________________________

Rehabilitated: ____________________________________________

Owned: ____________________________________________

Managed: ____________________________________________

Constructed: ____________________________________________

2. Estimate percentage of above total housing units produced that served low and moderate income persons:

30% of median and below: ____________________________________________



3. Number of employees/ volunteers in organization: ____________________________________________

Full time: ____________________________________________

Part time: ____________________________________________

Volunteers: ____________________________________________

4. Number of employees/ volunteers to work on project: ____________________________________________

Full time: ____________________________________________

Part time: ____________________________________________

Volunteers: ____________________________________________

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FORM 10

____________________2MSA refers to Metropolitan Statistical Area Median Income: See Resource Manual

Does the project involve any temporary relocation? Yes ❑ No ❑

PROJECTS REQUIRING PERMANENT RELOCATION WILL NOT BE CONSIDERED


AFFORDABLE RENTAL HOUSING CAPITAL PROJECTS PROPOSED OCCUPANCY AND RENT SCHEDULES


COMPLETE FOR RENTAL PROJECTS ONLY:

Occupancy Income Limits*:

Total # Units in Proposed Project:

Affordable Units:

____________ # units at or below 30% MSA ____________ # units at or below 60% MSA

____________ # units at or below 50% MSA ____________ # units at or below 80% MSA

____________ # units for persons with disabilities

Market Rate Units:

____________ # units at market rate

RENT SCHEDULE:

UNIT TYPE TOTAL NO. OF RENT UTILITIES POPULATION SERVED UNITS BY TYPE AS % OF MSA* OR NEED

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contract costs (Fill in shaded areas only.) subtotal total ccfp request 1. Land Improvements a. Off-Site b. On-Site c. Landscaping d. Engineering Fee (construction)SUBTOTAL LAND IMPROVEMENTS 2. Structures a. Residential b. Non-ResidentialSUBTOTAL STRUCTURES 3. Other costs a. General Requirements b. Builders Overhead c. Builders Profit d. Developers Fee e. Building Permits f. Completion Assurance Letter of Credit g. Consultant Fee h. Other (describe)SUBTOTAL OTHER COSTS development costs 1. Site Engineering/Survey 2. Design & Supervising Architect(s) 3. Soil Borings/Geotechnical 4. Environmental Phase I 5. Appraisal 6. Mortgage Placement Fee 7. Construction Interest 8. Taxes during Construction 9. Insurance during Construction 10. Title/Recording Expense 11. Legal Fees 12. Cost CertificationSUBTOTAL DEVELOPMENT COSTS land/acquisition/development costs 1. Total Improvement Cost 2. Cost of Land/Acquisition 3. OtherSUBTOTAL LAND/ACQUISITION/DEVELOPMENT TOTAL DEVELOPMENT COST MU

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FORM 11


AFFORDABLE RENTAL HOUSING CAPITAL PROJECTS DETAILED ESTIMATE OF DEVELOPMENT COSTS


SOURCE OF DATA ON WHICH ESTIMATES ARE BASED: _____________________________________________________

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FORM 12


AFFORDABLE RENTAL HOUSING CAPITAL PROJECTS DETAILED PRO FORMA (ESTIMATE OF ANNUAL OPERATING EXPENSES)



EXPENSE (Fill in shaded areas only.) per unit annual subtotal/totalADMINISTRATIVE

Advertising/MarketingOffice CostsManagement Fee % EGISalariesLegalAuditingBookkeeping/Accounting FeesTelephoneOther AdministrativeTOTAL ADMINISTRATIVE

UTILITIESFuel OilElectricWaterGasSewerTOTAL UTILITIES

OPERATING & MAINTENANCEJanitor/Cleaning CostExterminating CostTrash RemovalSecurity CostGrounds CostMaintenance/Repairs CostElevator Maintenance CostHeating/Cooling Repairs & MaintenanceSnow RemovalDecorating CostMiscellaneousTOTAL OPERATING & MAINTENANCE

TAXES AND INSURANCE Real Estate TaxesPayroll TaxesMiscellaneous Taxes/Licenses/PermitsProperty & Liability InsuranceOther InsuranceFidelity BondWorkers’ CompensationHealth Insurance & Employee BenefitsTOTAL TAXES AND INSURANCE

TOTAL OPERATING EXPENSES Replacement Reserves TOTAL EXPENSES

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FORM 13


AFFORDABLE RENTAL HOUSING CAPITAL PROJECTS PROJECT COSTS AND FINANCING



TOTAL DEVELOPMENT COSTS (From Form 11): $

TOTAL DEVELOPMENT COST PER UNIT: $

PROJECT FINANCING: (If additional space is needed, insert no more than one additional page following this one, and clearly label as Form 13)

Proposed CDBG Program Funds $

Equity

Source: __________________________ Amt: $_______________ Committed Yes ❑ No ❑



Total Equity $

Loans

1st Trust $ _______________ at _____% for ______ months Source __________________________ Committed ( Yes ❑ No ❑ )

2nd Trust $ _______________ at _____% for ______ months Source __________________________

Committed ( Yes ❑ No ❑ )

3rd Trust $ _______________ at _____% for ______ months Source __________________________

Committed ( Yes ❑ No ❑ )

Total Loans $

TOTAL PROJECT FINANCING $

CDBG AS % OF TOTAL PROJECT FINANCING: %

Do you expect to use FCRHA-issued tax-exempt bonds for any part of the financing? Yes ❑ No ❑

Do you plan to sell tax credits to raise equity? Yes ❑ No ❑

If yes, in what amount? $_____________________________

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FORM 14

FIVE-YEAR PROJECT YEAR 1 YEAR 2 YEAR 3 YEAR 4 YEAR 5 PRO FORMA ___________ ___________ ___________ ____________ ___________

ANNUAL REVENUES

1. Annual Rental Income $ $ $ $ $

2. Other Annual Income (list) _____________________ $ $ $ $ $

3. GROSS INCOME $ $ $ $ $

4. Minus 5% Vacancy Loss $ $ $ $ $

5. EFFECTIVE GROSS INCOME (#3 minus #4) $ $ $ $ $

6. Operating Expenses $ $ $ $ $

7. NET OPERATING INCOME (NOI) $ $ $ $ $ (NOI = #5 minus #6)

8. Debt Service $ $ $ $ $

9. CASH FLOW AFTER DEBT SERVICE $ $ $ $ $ (#7 minus #8)

10. DEBT COVERAGE RATIO (#7 / #8)

11. OPERATING COST per UNIT (#6 / Total # Units)


AFFORDABLE RENTAL HOUSING CAPITAL PROJECTS PRO FORMAPROJECT: __________________________________________ ORGANIZATION:_____________________________________

Provide information for each of the first five full years of stabilized occupancy. Please fill in the blanks with the actual years included in your projection.

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ATTACHMENT 1

In compliance with Fairfax County contracting protocols, the following certification is required by all applicants submitting a proposal, and all individuals and organizations awarded a contract:

1. The Board Chair certifies, to the best of his/her knowledge and belief, that the Applicant organization is financially solvent, and will remain so during the life of any contract awarded. The Board Chair will notify the county representative in writing of substantial solvency issues such as depletion of cash reserve accounts, use of cash reserves to meet payroll obligations, inability to meet obligations for accounts payable, evidence of deteriorating accounts receivable collection, evidence of delinquency in payment of IRS or payroll taxes, evidence of fraud or mismanage-ment, co-mingling of accounts, and/or use of grant funds for non-grant purposes.

2. The Executive Director certifies, to the best of his/her knowledge and belief, that the Applicant organization is financially solvent, and will remain so during the life of any contract awarded. The Executive Director will notify the county representative in writing within five business days of substantial solvency issues as outlined in #1 above.

3. This certification is a material representation of fact upon which reliance will be placed when mak-ing the award. If it is later determined that the applicant/contractor rendered an erroneous certi-fication, or if at any time during the course of the contract there are indications that the financial solvency of the contractor affects its ability to complete the terms of the contract, in addition to other remedies available to Fairfax County, the county may terminate the contract for default.

Printed Name of Board Chair: ___________________________________________________

Signature/Date: _________________________________________ /____________________

Printed Name of Executive Director: ______________________________________________

Signature/Date: _________________________________________ /____________________

Company Name: ____________________________________________________________

Address: ___________________________________________________________________

City/State/Zip: _______________________________________________________________

SSN or TIN: _________________________________________________________________

CERTIFICATION OF FINANCIAL SOLVENCY FOR NONPROFIT ORGANIZATIONS

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ATTACHMENT 2

In submitting this proposal, and signing below, offeror certifies the following in connection with the proposal or contract:

If #2 is selected, please complete the following:

Recipient: _________________________________________ Date of Gift:__________________

Description of the gift and its value: _________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Description of the consideration received in exchange and its value: _______________________

_____________________________________________________________________________

_____________________________________________________________________________

Printed Name of Bid\Representative: _______________________________________________

Signature/Date: ___________________________________________ /____________________

Company Name: _______________________________________________________________

Company Address: _____________________________________________________________

City/State/Zip: _________________________________________________________________

____________________

This certification supplements, but does not replace, the requirements set forth in Paragraph 64 (OFFICIALS NOT TO BENEFIT) of the General Conditions and Instructions to Bidders included in this solicitation.

CERTIFICATION REGARDING ETHICS IN PUBLIC CONTRACTING

1. I have not given any payment, loan, subscription, advance, deposit of money, services or anything of more than nominal or minimal value to any public employee or official having official responsibility for a procurement transaction.

2. I have given a payment, loan, subscription, advance, deposit of money, services or anything of more than nominal or minimal value to a public employee or of-ficial having official responsibility for a procurement transaction, but I received consideration in substantially equal or greater value in exchange.

CHECK ONE:

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ATTACHMENT 3

In compliance with contracts and grants agreements applicable under the U.S. Federal Awards Pro-gram, the following certification is required by all offerors submitting a proposal in response to this Request for Proposal:

1. The Contractor certifies, to the best of its knowledge and belief, that neither the Contractor nor its Principals are suspended, debarred, proposed for debarment, or declared ineligible for the award of contracts from the United States federal government procurement or nonprocurement programs, or are listed in the List of Parties Excluded from Federal Procurement and Nonprocure-ment Programs issued by the General Services Administration.

2. “Principals,” for the purposes of this certification, means officers, directors, owners, partners, and persons having primary management or supervisory responsibilities within a business entity (e.g., general manager, plant manager, head of a subsidiary, division, or business segment, and similar positions).

3. The Contractor shall provide immediate written notice to the Fairfax County Purchasing Agent if, at any time prior to award, the Contractor learns that this certification was erroneous when submitted or has become erroneous by reason of changed circumstances.

4. This certification is a material representation of fact upon which reliance will be placed when making the award. If it is later determined that the Offeror rendered an erroneous certification, in addition to other remedies available to Fairfax County government, the Fairfax County Purchasing Agent may terminate the contract resulting from this solicitation for default.

Printed Name of Representative: ________________________________________________

Signature/Date: _________________________________________ /____________________

Company Name: ____________________________________________________________

Address: ___________________________________________________________________

City/State/Zip: _______________________________________________________________

SSN or TIN No: ______________________________________________________________

CERTIFICATION REGARDING DEBARMENT OR SUSPENSI0N

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ATTACHMENT 4

VIRGINIA STATE CORPORATION COMMISSION (SCC) REGISTRATION INFORMATION

Is a corporation or other business entity with the following SCC identification

number: ____________________________________

-OR-

Is not a corporation, limited liability company, limited partnership, registered limited liability partnership, or business trust

-OR-

Is an out-of-state business entity that does not regularly and continuously maintain as part of its ordinary and customary business any employees, agents, offices, facilities, or inventories in Virginia (not counting any employees or agents in Virginia who merely solicit orders that require acceptance outside Virginia before they become contracts, and not counting any incidental presence of the bidder in Virginia that is needed in order to assemble, maintain, and repair goods in accordance with the contracts by which such goods were sold and shipped into Virginia from bidder’s out-of-state location)

-OR-

Is an out-of-state business entity that is including with this bid/proposal an opinion of legal counsel which accurately and completely discloses the undersigned bidder’s current contacts with Virginia and describes why those whose contacts do not constitute the transaction of business in Virginia within the meaning of § 13.1 757 or other similar provisions in Titles 13.1 or 50 of the Code of Virginia.

Please check the box on left if you have not checked any of the foregoing options but currently have pending before the SCC an application for authority to transact business in the Commonwealth of Virginia and wish to be considered for a waiver to allow you to submit the SCC identification number after the due date for bids.

THE BIDDER:

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TECHNICAL PROPOSAL All addenda MUST be signed and MUST accompany the proposal.

❑ FORM 1 — Proposal Cover Sheet (DPMM32)

❑ Table Of Contents

❑ FORM 2 — Proposal Narrative Written Narrative (Includes Demonstration of Need, Outcomes,

Approach, Organizational Capacity)

❑ FORM 3 — Program Outcome Worksheet

COST PROPOSAL

❑ FORM 4 — Program Budget

❑ FORM 4A — Program Personnel Budget

❑ FORM 4B — Program Budget Justification

❑ FORM 5 — Estimated Program Revenues

RENTAL HOUSING CAPITAL PROJECTS ONLY

❑ FORM 6 — Development Project Summary

❑ FORM 7 — Housing Blueprint & Consolidated Plan Priority Needs & Non-Homeless Special Needs

❑ FORM 8 — Impact on Affordable Rental Housing Stock

❑ FORM 9 — Applicant Experience & Qualifications

❑ FORM 10 — Proposed Occupancy & Rent Schedules

❑ FORM 11 — Detailed Estimate of Development Costs

❑ FORM 12 — Detailed Estimate of Annual Operating Expenses

❑ FORM 13 — Project Costs & Financing

❑ FORM 14 — Pro Forma

PROPOSAL CHECKLIST

ATTACHMENTS

❑ Current Board of Director’s Roster (including phone numbers and email addresses)

❑ Program Position Descriptions

❑ Program Staff Resumes

❑ Unaudited Financial Statements (October 31, 2017)

❑ 2016 Federal Tax Form 990

❑ FY 2017 Organization-wide Budget

❑ Certification of Financial Solvency (Attachment 1)

❑ Certification Regarding Ethics in Public Contracting (Attachment 2)

❑ Certification Regarding Debarment or Suspension (Attachment 3)

❑ Virginia State Corporation Commission (SCC) Registration Information Form (Attachment 4)

❑ Cooperative Agreement or Letter (if applicable)

❑ Memorandum of Agreement (if applicable)

❑ 501(c)3 (if applicable)

HOUSING PROJECTS ONLY

❑ Cost Estimates for Rehabilitation Work

❑ Community-Based Development Organization (CBDO) Checklist (page 58 of Resource Manual)

Late proposals (after 2:00 p.m.) will not be accepted or considered for contract award, and will be returned to the applicant.

request for proposal - fairfaxcounty.gov · a joint proposal, the proposal may ... community...

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